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<body>

<table border="0" cellpadding="0" cellspacing="0" width="650" height="2">
  <tr>
    <td colspan="2" align="center"><b>CỘNG HOÀ XÃ HỘI CHỦ NGHĨA VIỆT NAM
     <br>
Độc lập-Tự                  
    do -Hạnh phúc</b></td>
  </tr>
  <tr>
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style='font-size: 10.0pt; mso-font-kerning: 14.0pt'><font face="Times New Roman">***************</font></span></span></td>
  </tr>
  <tr>
    <td height="1" colspan="2">&nbsp;</td>
  </tr>
  <tr>
    <td height="1" colspan="2" align="center"> <strong><font size="4">ĐƠN XIN GIA HẠN GIẤY PHÉP        
XÂY DỰNG <br>
CÔNG TRÌNH VÀ NHÀ Ở ĐÔ THỊ </font></strong></td>
  </tr>
  <tr>
    <td height="1" colspan="2">&nbsp;</td>
  </tr>
  <tr>
    <td width="3%">&nbsp;</td>
    <td width="97%" height="1"><table CLASS="MsoNormalTable" BORDER="1" CELLSPACING="0" CELLPADDING="0"
STYLE="border-collapse: collapse; mso-table-layout-alt: fixed; mso-border-alt: solid windowtext .5pt; mso-padding-alt: 0in 5.4pt 0in 5.4pt; mso-border-insideh: .5pt solid windowtext; mso-border-insidev: .5pt solid windowtext; border-style: none; border-width: medium; margin-left: 310.2pt"
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STYLE="mso-border-alt: solid windowtext .5pt; border: 1.0pt solid windowtext; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0in; padding-bottom: 0in" height="1" NOWRAP
ALIGN="center" CLASS="table"><p CLASS="MsoNormal2"><font SIZE="3" FACE="Times New Roman"> Xây dựng mới</font></p>
            <p CLASS="MsoNormal2"><font SIZE="3" FACE="Times New Roman"> Cải tạo, sửa chữa
                  <o:p> </o:p>
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STYLE="mso-border-left-alt: solid windowtext .5pt; mso-border-alt: solid windowtext .5pt; border-left-style: none; border-left-width: medium; border-right: 1.0pt solid windowtext; border-top: 1.0pt solid windowtext; border-bottom: 1.0pt solid windowtext; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0in; padding-bottom: 0in"
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            <o:p> &nbsp; </o:p>
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        <td WIDTH="34" VALIGN="top"
STYLE="mso-border-top-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-alt: solid windowtext .5pt; border-left-style: none; border-left-width: medium; border-right: 1.0pt solid windowtext; border-top-style: none; border-top-width: medium; border-bottom: 1.0pt solid windowtext; padding-left: 5.4pt; padding-right: 5.4pt; padding-top: 0in; padding-bottom: 0in"
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    <td>&nbsp;</td>
    <td height="1"><font face="Times New Roman" size="4">Kính gửi:&nbsp;- Ủy ban nhân dân&nbsp; Huyện Tân Thành</font></td>
  </tr>
  <tr>
    <td height="1" colspan="2">&nbsp;</td>
  </tr>
  <tr>
    <td height="1" colspan="2"><span class="MsoNormal" style="word-spacing:0in"><font face="Times New Roman"><b style="mso-bidi-font-weight:
normal">I-Tên chủ đầu tư (tổ chức, cá nhân), xin phép xây dựng:
            <o:p> </o:p>
    </b><b style="mso-bidi-font-weight: normal">&nbsp;</b></font></span></td>
  </tr>
  <tr>
    <td>&nbsp;</td>
    <td height="1">Người đại diện (chủ đầu tư) :&nbsp; NGUYỄN THỊ TUYẾT MAI</td>
  </tr>
  <tr>
    <td>&nbsp;</td>
    <td height="1">Địa chỉ liên hệ:&nbsp;</td>
  </tr>
  <tr>
    <td>&nbsp;</td>
    <td height="1">Nhà số: &nbsp; 36547&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Ngõ: &nbsp; 665fhgf</td>
  </tr>
  <tr>
    <td>&nbsp;</td>
    <td height="1">Đường phố: &nbsp;&nbsp; Xã (thị trấn):  &nbsp;<br> 
    Quận (huyện): &nbsp; Tân Thành</td>
  </tr>
  <tr>
    <td>&nbsp;</td>
    <td height="1">Số điện thoại:&nbsp;&nbsp; 65475665&nbsp;&nbsp; Fax: &nbsp;&nbsp;&nbsp;</td>
  </tr>
  <tr>
    <td height="10" colspan="2"></td>
  </tr>
  <tr>
    <td height="1" colspan="2"><b>II-Nội dung xin phép xây dựng:</b></td>
  </tr>
  <tr>
    <td>&nbsp;</td>
    <td height="1">Loại công trình: Công trình</td>
  </tr>
  <tr>
    <td>&nbsp;</td>
    <td height="1">Diện tích xây dựng (Tầng 1): 654765 m<sup>2 </sup>Tổng diện tích sàn: 54765 m<sup>2</sup></td>
  </tr>
  <tr>
    <td>&nbsp;</td>
    <td height="1">Số tầng: 6&nbsp; Chiều cao tới đỉnh mái&nbsp; 5657 m </td>
  </tr>
  <tr>
    <td height="10" colspan="2"></td>
  </tr>
  <tr>
    <td height="1" colspan="2"><b>III-Địa điểm xây dựng:</b>&nbsp; reytnvbmbn</td>
  </tr>
  <tr>
    <td>&nbsp;</td>
    <td height="1">Lô đất số:&nbsp;bvcnbvm diện tích: 5657 m<sup>2</sup>&nbsp;&nbsp; tại&nbsp; 54757</td>
  </tr>
  <tr>
    <td>&nbsp;</td>
    <td height="1">Đường phố:&nbsp; 5sdhfgh&nbsp;Xã (thị trấn): &nbsp; Xã Hội Bài </td>
  </tr>
  <tr>
    <td>&nbsp;</td>
    <td height="1">Quận (huyện):  Tân Thành&nbsp; Tỉnh (thành phố): Bà Rịa - Vũng Tàu.</td>
  </tr>
  <tr>
    <td>&nbsp;</td>
    <td height="1">Nguồn gốc đất đai: Nhận quyền sử dụng đất theo kết quả đấu giá quyền sử dụng đất</td>
  </tr>
  <tr>
    <td height="10" colspan="2"></td>
  </tr>
  <tr>
    <td height="1" colspan="2"><b style="mso-bidi-font-weight:normal">IV-Tổ chức, cá nhân thiết kế:</b> &nbsp; xzgbcvjnbvn</td>
  </tr>
  <tr>
    <td>&nbsp;</td>
    <td height="1">Địa chỉ:&nbsp; nbvnmbvnvb</td>
  </tr>
  <tr>
    <td>&nbsp;</td>
    <td height="1">Số điện thoại: 54765856 </td>
  </tr>
  <tr>
    <td height="10" colspan="2"></td>
  </tr>
  <tr>
    <td height="1" colspan="2"><b>V-Lời cam đoan:</b> Tôi xin cam đoan</td>
  </tr>
  <tr>
    <td>&nbsp;</td>
    <td height="1">
      <p style="text-align:justify">
  &nbsp;&nbsp;&nbsp; - Làm theo đúng giấy phép, thiết kế đã được cơ quan cấp giấy phép xây dựng duyệt.<br>
&nbsp;&nbsp;&nbsp; - Có trách nhiệm sửa chữa, bồi hoàn đối với chủ sở hữu các công trình kế cận do việc tiến hành xây dựng công trình gây ra (Lún, nứt, đổ   
        vỡ, làm biến dạng công trình .vv.)
      <br>
&nbsp;&nbsp;&nbsp; - Nếu sai tôi hoàn toàn chịu trách nhiệm và chịu xử lý theo quy định của Pháp luật.
      </p></td>
  </tr>
  <tr>
    <td>&nbsp;</td>
    <td height="1"><table width="100%" border="0" cellspacing="0" cellpadding="0">
      <tr>
        <td colspan="2">&nbsp;</td>
        </tr>
      <tr>
        <td><b><i>Kèm theo đơn: </i></b></td>
        <td><i> 1. Bản chính giấy phép xây dựng đã được cấp</i></td>
      </tr>
      <tr>
        <td width="16%"><b><i>Giấy tờ khác:</i></b></td>
        <td width="84%"><i></i></td>
      </tr>
    </table></td>
  </tr>
  
  <tr>
    <td>&nbsp;</td>
    <td height="1">&nbsp;</td>
  </tr>
  <tr>
    <td height="1" colspan="2">
      <table BORDER="0" WIDTH="100%">
      <tr>
        <td WIDTH="51%" ALIGN="center"><b>Xác nhận của UBND <br>
Huyện Tân Thành</b></td>
        <td WIDTH="49%" ALIGN="center"><i>ng&#224;y 07 th&#225;ng 08 n&#259;m 2007</i><br>
<b>ĐẠI DIỆN CHỦ ĐẦU TƯ CÔNG TRÌNH
                 
          </b></td>
      </tr>
        </table></td>
  </tr>
</table>
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